Question:
I was approved for sugery-after sugery insurance will not pay!
I had my sugery on May 16. My doctor submitted for approval to my insurance (BCBS OF MN) in March. My insurance approved WLS and even approved pre admittance for the hospital stay. I am now six weeks post op and now and I am receiving EOB'S from insurance saying that this procedure is excluded? Can my insurance be forced to pay for this procedure after they said I was approved. I have all the paper work stating that I was approved. I am fighting an infection from WLS and at the time I don't need anything else to worry about. Any information or comments will be greatly appreciated. Please someone tell me what to do! — Gene F. (posted on June 25, 2003)
June 24, 2003
I have a comment, DO NOT PAY!!!!!!!!! If they approved it then they HAVE to
pay it. Be strong and fight them! Good luck
rny 10/15/02-269 lbs
6/25/03-140 lbs
— Lori M.
June 25, 2003
The same thing happened to me with United Healthcare PPO. I got my approval
in late December, had my surgery in early February and they refused to pay
stating weight loss surgery was excluded. What happened is a new policy had
gone into effect on January 1st with an exclusion in it. However, since I
had received my approval prior to the exclusion going into effect, after a
couple of phone calls from me, they finally did end up paying.
Good luck.
— kathyb
June 25, 2003
I disagree with the previous poster. I am a RN and work in the field and
when you call a insurance company the first thing they say is " an
authorization is NOT a gurantee of payment." Though I do feel that you
can fight this knowing that they did agree that you need to have this done.
I feel that if you fight this you will when and they will pay. DO NOT GIVE
UP.. Best Wishes... Krysti
— Krysti H.
June 25, 2003
I'm having the same problem with the same insurance. I have requested a
review.Since the review, the insurance has now paid the hospital and the
anesthesia doctor.I'm still fighting for them to pay the surgeon and the
assistant surgeon. Keep fighting the insurance company and if that doesn't
work call the hospital and doctor and arrainge for a lessor pay. The
hospital will usually settle for about $3,000.00.The Doctor will usually
settle for about $6,000.00 which you can make payments.Hope this helps.
Good luck
— myra J.
June 25, 2003
I am having the same problem with my TT. I was pre-approved and then they
said they wouldn't pay. You need to call them and have your surgeons
office call them. Tell them that you have the pre-approval number and if
it isn't paid immediately you will turn it over to legal counsel. DO NOT
PAY!!!!!!
— Linda A.
June 25, 2003
Gene, call customer service and ask them to check your authorization. If
you have something written that includes an authorization number or some
sort of code, that might be helpful. It could be human error. That's part
of the reason EOBs go out - it's the member's responsibility to make sure
they are, to some degree, correct. It could be entirely possible that
between the time you got the EOB and the claim was actually paid, that the
error was fixed. If not, and you have documentation from the insurance
company, you certainly can appeal to have your claims paid.
— koogy
June 26, 2003
I wouldn't panic it could be anything. Your doctors office could of even
coded the claims wrong. I would call your insurance company and talk with
a claims supervisor and explain the situation. Unless you are on some type
of 80/20 plan you shouldn't have to worry about medical bills.
— Jennifer M.
June 26, 2003
Hi, I maybe wrong but I was told, that if they send things to a collect
agency you have the right to say I don't owe this money. At this point,
they have to prove you do and you submit copies (never the orginals)of you
proof and they have to fight for you since you have the proof. Good Luck.
I had to do that with my breast reduction. They sent a letter saying I was
right. :-)
— RAQUEL S.
June 26, 2003
hey Gene, I work for a insurance company, Believe me one of the things that
get their attention is to tell them you will go public, that you have all
your approvals, and you will take them to court, mention that you have an
atty. It's amazing how fast they will react when you have your approvals in
hand and then they hear atty. Good Luck
— LS F.
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